Healthcare’s Dissatisfaction With Payer Reimbursements Continues

Experian Health State of Claims survey reveals denials are tormenting providers with little optimism for relief

COSTA MESA, Calif.--(BUSINESS WIRE)--The struggle with claim denials in the healthcare industry continues to get worse, and a regression in technology adoption to solve issues is adding fuel to the fire, according to the Experian Health 2024 State of Claims survey. Compared to the same study conducted in 2022, almost 3 out of 4 providers surveyed say claim denials are increasing, showing an uptick of 31 percent while confidence levels in leveraging automation and artificial intelligence dropped by more than 25 percent.

Numbers going in the wrong direction

Coinciding with the increase in claim denials was a negative uptick in provider sentiment across several categories compared to the prior survey in 2022, including:

• 77 percent of providers surveyed say payer policy changes occur with more frequency vs. 67 percent
• 67 percent of providers surveyed say time to be reimbursed is increasing vs. 51 percent
• 55 percent of providers surveyed say errors in claims are increasing vs. 43 percent

What is causing the rise in claim denials?

The top three reasons survey respondents chose are the following:

• Missing or inaccurate data (46%)
• Authorizations (36%)
• Patient information inaccurate/not complete (30%)

As the need for effective solutions becomes more dire, Experian Health has launched innovative revenue cycle products, including its Patient Access Curator, which allows providers to leverage real-time automated discovery of patient data to prevent denials.

“We had hoped to see a decrease in claim denials from our previous survey, but it’s clear these significant challenges are continuing, adding immense pressure on providers to improve their revenue cycle management processes,” said Clarissa Riggins, Chief Product Officer at Experian Health. “This growing crisis is a sign that traditional approaches are no longer enough, and providers should adopt more proactive strategies and the latest technology to navigate this volatility.”

Going back to the old ways

Unfortunately, providers are lacking confidence in their current solutions and unsure of new technology. Just 54 percent of survey respondents say their organization’s technology is sufficient to address existing revenue cycle management demands compared to 77 percent in 2022. Providers that use some form of automation and/or AI technology also decreased, from 62 percent in 2022 to 31 percent in 2024, while providers that have not considered or evaluated automation technology increased from 5 percent to 28 percent. Why? It seems the comfort gap has plummeted with those that are very or extremely confident in understanding automation, machine learning and AI at only 28 percent compared to 68 percent two years ago.

To access the free State of Claims report, go here. The survey was conducted among 210 healthcare staff responsible for administration in finance, billing, registration, reimbursements, claims and collections. Participants include chief officers, presidents, vice presidents, directors and administrators.

Experian Health aims to simplify healthcare and offers providers patient engagement and revenue cycle management solutions to reduce claim denials including the artificial-intelligence-powered product AI Advantage and new Patient Access Curator. For more information, visit www.experian.com/health.

About Experian Health

At Experian Health, we serve more than 60 percent of U.S. hospitals and more than 7,500 medical practices, labs, pharmacies and other healthcare providers to simplify healthcare with data-driven platforms and insights that help our clients make smarter business decisions, deliver a better bottom line and establish strong patient relationships.

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We invest in talented people and new advanced technologies to unlock the power of data and innovate. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

For more information about Experian Health, visit http://www.experianhealth.com. Learn more about Experian at www.experianplc.com.